Early Additional Immune-Modulators for Mycoplasma pneumoniae Pneumonia in Children: An Observation Study
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Background: Mycoplasma pneumoniae (MP) pneumonia is a self-limiting disease, but some patients complain of progressivepneumonia, despite of appropriate antibiotic treatment. We aimed to introduce the role of immune-modulators (corticosteroidand/or intravenous immunoglobulin, IVIG) treatment for childhood MP pneumonia based on previous our experiences. Materials and Methods: A retrospective case series analysis for 183 children with MP pneumonia was performed. MP pneumoniapatients were diagnosed by two Immunoglobulin M (IgM) tests: the micro-particle agglutination method (>1:40) and the cold agglutinationtest (>1:4), and were examined twice at the initial admission and at discharge. Among 183 MP pneumonia patients, 90 patientswith persistent fever for over 48 hours after admission or those with severe respiratory symptoms and signs received additional prednisolone(82 patients, 1 mg/kg/day) or intravenous methylprednisolone (8 patients, 5-10 mg/kg/day) with antibiotics. Four patients withaggravated clinical symptoms and chest radiographic findings after corticosteroid treatment received IVIG (1 g/kg/day, 1-2 doses). Results: Mean age of 183 patients was 5.5 ± 3.2 years (6 months-15 years), and the male: female ratio was 1.1:1 (96:87). Fifty-seven patients (31%) were seroconverters and 126 seropositive patients showed increased diagnostic IgM antibody titresduring admission (over 4 folds). The majority of the patients who received corticosteroids (86/90 cases) showed rapid defervescencewithin 48 hours with improved clinical symptoms, regardless of the used antibiotics. Also, 4 patients who received additionalIVIG improved both clinically and radiographically within 2 days without adverse reaction. Conclusions: In the era of macrolide-resistant MP strains, early additional immune-modulator therapy with antibiotics mightprevent from the disease progression and reduce the disease morbidity without adverse reaction.
Abstract
Background: Mycoplasma pneumoniae (MP) pneumonia is a self-limiting disease, but some patients complain of progressivepneumonia, despite of appropriate antibiotic treatment. We aimed to introduce the role of immune-modulators (corticosteroidand/or intravenous immunoglobulin, IVIG) treatment for childhood MP pneumonia based on previous our experiences. Materials and Methods: A retrospective case series analysis for 183 children with MP pneumonia was performed. MP pneumoniapatients were diagnosed by two Immunoglobulin M (IgM) tests: the micro-particle agglutination method (>1:40) and the cold agglutinationtest (>1:4), and were examined twice at the initial admission and at discharge. Among 183 MP pneumonia patients, 90 patientswith persistent fever for over 48 hours after admission or those with severe respiratory symptoms and signs received additional prednisolone(82 patients, 1 mg/kg/day) or intravenous methylprednisolone (8 patients, 5-10 mg/kg/day) with antibiotics. Four patients withaggravated clinical symptoms and chest radiographic findings after corticosteroid treatment received IVIG (1 g/kg/day, 1-2 doses). Results: Mean age of 183 patients was 5.5 ± 3.2 years (6 months-15 years), and the male: female ratio was 1.1:1 (96:87). Fifty-seven patients (31%) were seroconverters and 126 seropositive patients showed increased diagnostic IgM antibody titresduring admission (over 4 folds). The majority of the patients who received corticosteroids (86/90 cases) showed rapid defervescencewithin 48 hours with improved clinical symptoms, regardless of the used antibiotics. Also, 4 patients who received additionalIVIG improved both clinically and radiographically within 2 days without adverse reaction. Conclusions: In the era of macrolide-resistant MP strains, early additional immune-modulator therapy with antibiotics mightprevent from the disease progression and reduce the disease morbidity without adverse reaction.
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